E-ISSN:2456-3110

Review Article

Perimenopause

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 12 DECEMBER
Publisherwww.maharshicharaka.in

Perimenopause: A Gentle Transition through Ayurveda

Inchara P1*, Rachana HV2
DOI:10.21760/jaims.9.12.14

1* Inchara P, Post Graduate Scholar, Department of Prasuti Tantra and Stree Roga, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.

2 Rachana HV, Professor, Department of Prasuti Tantra and Stree Roga, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.

Perimenopause represents a profound juncture in a woman's life, bridging her reproductive years to the cessation of menstruation in menopause. Modern medicine views perimenopause as a transitional phase marked by hormonal fluctuations, typically manifesting in symptoms such as hot flashes, night sweats, mood swings, irregular menstrual cycles, and changes in bone density. These physiological changes often impact a woman's quality of life and well-being, prompting the need for effective management strategies. In contrast, Ayurveda, the ancient holistic healing system, perceives perimenopause as a natural progression influenced by the balance of Doshas - Vata, Pitta, and Kapha - within the body. According to Ayurvedic principles, imbalances in these Doshas can exacerbate symptoms experienced during perimenopause. Therefore, Ayurvedic interventions focus on restoring Doshic equilibrium through personalized dietary recommendations, lifestyle modifications, herbal supplements, and therapeutic practices.

Keywords: Perimenopause, menopause transition, Rajonivrutti, Rasayana, Panchakarma

Corresponding Author How to Cite this Article To Browse
Inchara P, Post Graduate Scholar, Department of Prasuti Tantra and Stree Roga, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.
Email: 		Inchara P, Rachana HV, Perimenopause: A Gentle Transition through Ayurveda. J Ayu Int Med Sci. 2024;9(12):116-112.
Available From
https://jaims.in/jaims/article/view/3895

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-11-14 2024-11-23 2024-12-04 2024-12-14 2024-12-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.75

© 2024by Inchara P, Rachana HVand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

J Ayu Int Med Sci 2024;9(12)116
Download PDFBack To ArticleIntroductionMaterials and MethodsDiscussionConclusionReferences
Inchara P et al. Perimenopause: A Gentle Transition through Ayurveda

Introduction

Perimenopause is a significant yet often misunderstood phase in a woman's life, representing the transition from reproductive age to menopause. It is a period characterized by hormonal fluctuations, most notably in estrogen and progesterone levels, which can lead to a variety of physical, emotional, and psychological changes. Whereas, Menopause means permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity. The premenopause refers to period prior to menopause, postmenopause to period after menopause and perimenopause to period around menopause.

Perimenopause is the part of the climacteric when the menstrual cycle is likely to be irregular [1]. Women typically begin the shift from a reproductive state to non-reproductive state during their mid-to late 40s, and they remain in this transitory state for approximately 4–5 years before reaching menopause. This can last for several years also.

Perimenopause culminates with menopause, when menses have ceased for a period of at least 12 consecutive months.[2]

The menopause transition is experienced by 1.5 million women each year.[3] During this menopause transition women experiences variety of psychosomatic symptoms such as Depression, Forgetfulness Irritability, Insomnia, Loss of concentration, Anxiety, Hot flushes, Night sweats, Headache, urinary symptoms, Joint pains, vascular endothelial disorders, Cognitive impairments, Dementia, skin & hair problems.[4] The main treatment includes HRT either estrogen alone or with the combination of progesterone.

In Ayurveda there is no much references are found as it is considered as a part of physiological changes and menopause is considered as Rajonivrutti and there no exact term in Ayurveda which describes for perimenopause or menopause transition.

This can be understood in terms of Swabhava, Jarapakvasharira due to Kala, Dhatukshaya, Effect of Dosha, Vayu, Abhighata.[5]

Materials and Methods

All available References of Perimenopause, menopause,

menopausal Syndrome and Rajonivrutti have been collected from literatures, Ayurvedic Samhitas, Ayurvedic textbooks and modern text books, different websites, published articles, are collected and critically examined.

Discussion

In Ayurveda, health is understood through the balance of three fundamental energies or Doshas: Vata, Pitta, and Kapha. Each Dosha has distinct characteristics and influences specific bodily functions. Perimenopause is viewed as a time of natural Doshic imbalance, often requiring specific interventions to restore harmony. Perimenopause can be understood in terms of imbalance of three Doshas. The first stage is Kapha and occurs from conception to around the pre-teen years, in other words, childhood. The second stage is governed by Pitta and spans from teen years i.e., start of the menstrual cycle for females up until menopause. The third stage is governed by Vata up to our last breath and it's at this stage of perimenopause transition and menopause.

In menopausal transition there is a shift from a Pitta to a Vata - dominated stage of life, due to this transition, the Estrogen levels surge throughout the final reproductive years. These hormonal changes can disrupt the bioenergetic field as the body finds its new equilibrium - sparking lighter (or heavier) periods, lower libido, fatigue, and body aches also women feel more anxious, stressed, reactive, or simply “off.”

So, role of Pitta during perimenopause can be understand as:

  • Metabolic Changes: Pitta Dosha regulates metabolic activities in body. During perimenopause, metabolic rates may fluctuate, leading to weight changes, hot flashes, & night sweat. These are direct manifestations of Pitta's
  • Hormonal Changes: Pitta is closely linked to the endocrine system. The fluctuations in estrogen and progesterone levels during perimenopause are governed by Pitta, contributing to symptoms like irritability, mood swings, and hot flashes.
  • Emotional and Psychological Impact: Pitta also influences the mind and emotions, often leading to increased irritability, anger, and impatience during perimenopause.

J Ayu Int Med Sci 2024;9(12)117
Inchara P et al. Perimenopause: A Gentle Transition through Ayurveda

While the primary transition during menopause is from Pitta to Vata, Kapha also plays a role in this process. Although Kapha is not the primary Dosha during menopause, its characteristics and imbalances can still influence the transition. The transition phase of Kapha can be explained as follows:

  • Weight Gain: As metabolism slows, there can be an increase in Kapha, leading to weight gain and fluid retention.
  • Depression and Lethargy: Excess Kapha can cause feelings of heaviness, lethargy, and depression. This contrasts with the anxiety and restlessness of Vata but can occur in some women.
  • Joint Pain and Stiffness: With the decrease in estrogen, the body may experience joint pain and stiffness, which are influenced by both Vata and Kapha.

Transition Phase

  • Shift in Dominance: As menopause approaches, there is a natural shift from the Pitta phase of life (middle age) to the Vata phase (elderly). This transition brings a change in the predominant Dosha affecting the body and mind.
  • Symptoms of Vata Dominance: The onset of menopause brings Vata qualities like dryness (vaginal dryness, dry skin), irregularity (irregular menstrual cycles), and instability (mood swings, anxiety). These symptoms reflect the increasing influence of Vata Dosha.

Kashyapa describes Artavaotpatti (menarche), but the age given there, is only Praayika (probable) and not the exact. Depending upon the Ahara and Vihara and Arogya of the female, age of menarche and menopause may differ by a few years which are practically seen around 45-55 years. Whereas Bhela and Dalhana clarify that the reason for nonappearance of raja before menarche is Aparipurna Dhatu Avastha (immaturity of body system), whereas the reason for its debilitation at the age 50 is because of Kshaya of Shareera Dhatu due to aging.[6]

Imbalances in Vata - dominated individuals may experience increased anxiety and insomnia,Pitta types might face hot flashes and irritability andKapha dominance person could lead to weight gain and sluggishness.

For all these, Vata is the one which is responsible for the equilibrium of other Doshas.

Since perimenopause is the stage of Vata predominant, understanding the functions of Vata and its imbalance becomes necessary. Acharya Charaka has elaborately described the various activities of Vata Dosha in Charaka Samhita, Sutrasthana, 12th chapter among those some of the symptom’s which can be correlated to perimenopause are:

  • Niyanta Praneta Cha Manasa - Vata restrains and impels the mental activities.
  • Sarvashariradhatuvyuhakara - Vata brings about compactness in all the tissue elements of the body.
  • Samirano Agne - Vata ignites the digestive fire.
  • Sandhanakara Sharirasya - Vata brings together different parts of the body.
  • Harsha Utsaha Yoni - Vata is the causative factor of joy and courage.[7]

Even Acharya Sushruta has also described the various functions of Vata Dosha in Sushruta Samhita, Nidansthana, 1st chapter as-

  • Doshadhatwagnisamatam - Vata maintains the balance between Dosha, Dhatu and Agni.
  • Sampraptim Vishayeshu - Vata coordinates sensory organs with their objects and
  • Kriyanamanulomyam - Vata is responsible for proper functioning of all the physical and mental activities.[8]

Also, Acharya Vagbhata also described the various functions of Vata Dosha in Ashtanga Hridayam, Sutrasthana, 11th chapter as-

  • Utsaha (enthusiasm)
  • Ucchvas (inspiration)
  • Nihswas (expiration)
  • Chesta (movements)
  • Vegapravartanam (initiation of natural urges) and
  • Samyagatya Cha Dhatunamkshananam Patavena Cha (maintenance of body tissues in their normal state and proper functioning of the sense organs).[9]

Here if we consider perimenopause symptoms then there is:


J Ayu Int Med Sci 2024;9(12)118
Inchara P et al. Perimenopause: A Gentle Transition through Ayurveda
SignsSymptomsPredominant DoshaAyurvedic perception
Irregular menstrual cycles:often begins with changes in the menstrual cycle, including irregular periods, shorter or longer cycles, and variations in flowVataApana Vayu, a subtype of Vata, is responsible for the downward movement and elimination processes, including menstrual flow. Imbalance in Apana Vayu causes irregular menstrual cycles due to its erratic and unstable nature.
Hot flashes:Sudden feelings of intense heat, often accompanied by sweating and flushingPittaRanjaka Pitta, responsible for blood and liver metabolism, when imbalanced, increases internal heat, leading to the sensation of hot flashes.
Night sweats:Similar to hot flashes, night sweats involve sudden episodes of sweating during sleep, which can disrupt sleep patterns.PittaExcess Ranjaka Pitta increases internal body heat, particularly affecting the body's ability to cool down at night, leading to night sweats and disturbed sleep.
Mood swings:Hormonal fluctuations during perimenopause can lead to mood swings, irritability, anxiety, or depression.Vata and pittaPrana Vayu, a subtype of Vata, affects mental stability and clarity, leading to emotional instability and mood swings. Sadhaka Pitta, related to the emotions and intellect, when imbalanced, causes irritability and anger, contributing to mood swings.
Vaginal dryness:Decreased estrogen levels can result in vaginal dryness, itching, or discomfort during sexual intercourse.VataApana Vayu’s dry and rough qualities cause decreased lubrication and moisture in the pelvic region, resulting in vaginal dryness during perimenopause.
Decreased libido:Changes in hormone levels may affect libido or sexual desire in some women.Vata and kaphaApana Vayu imbalance leads to dryness and depletion, reducing sexual desire. Kledaka Kapha’s heaviness and sluggishness can decrease libido due to reduced energy and vitality.
Sleep disturbances:Perimenopausal women may experience difficulties falling asleep, staying asleep, or experiencing restful sleepVataPrana Vayu governs the mind and nervous system, while Vyana Vayu affects circulation. Imbalances in these Vata subtypes disrupt sleep patterns, causing insomnia and restlessness.
Fatigue:Some women may experience increased fatigue or lack of energy during this stageVata and kaphaPrana Vayu depletion leads to overall fatigue and reduced energy levels. Kledaka Kapha’s heavy and slow qualities contribute to feelings of lethargy and tiredness.
Weight gain:Changes in hormone levels and metabolism can contribute to weight gain, particularly around the abdomen.KaphaKledaka Kapha and Meda Dhatu (fat tissue) imbalances lead to weight gain. Kapha’s heavy, slow, and stable qualities result in increased fat accumulation during perimenopause.
Breast tenderness:Hormonal fluctuations may cause breast tenderness or changes in breast tissue during perimenopause.Pitta and KaphaRanjaka Pitta imbalance  causes inflammation, while Sleshaka Kapha, responsible for lubrication and tissue fluids, leads to fluid retention, resulting in breast tenderness.
Changes in skin and hair:Reduced estrogen levels may lead to changes in skin elasticity, dryness, and thinning hair.Vata and PittaVata causes dryness and brittleness in skin and hair. Bhrajaka Pitta, governing skin health, when imbalanced, leads to inflammation, skin issues, and hair problems.
Bone density loss:Estrogen decline increases the risk of osteoporosis and bone density loss in menopausal women.VataVata governs Asthi Dhatu (bone tissue). Its dry and light qualities contribute to the depletion and weakening of bones, leading to reduced bone density.

So, when it is considered the above symptoms the main cause for the perimenopause is the imbalances of three Doshas, among those, Vata is responsible for these imbalances. In Ayurveda, implementing lifestyle modifications, Dinacharya, Rutucharya, and suitable exercises plays a crucial role in maintaining overall health and effectively managing the symptoms during this period. Also, lifestyle modification includes, Yogasana and Pranayama thus reducing the stress of the individuals.

Dinacharya and Rutucharya for Perimenopause includes:

Time/SeasonPracticeDetailsDietBenefits
Brahma Muhurta (Early Morning)Abhyanga (Oil Massage)Use warm Sesame oil or Bala Taila. Focus on joints, spine, and extremities.lukewarm water to be taken after waking up.Nourishes skin, strengthens bones, pacifies Vata, and prevents dryness.
After AbhyangaSnana (Bathing)Bath with lukewarm water using herbal powders like Nalapamadi Churna or decoctions.light, warm breakfast: milk with dates, ghee, and rice preparations.Cleanses the body, reduces fatigue, and promotes relaxation.
Winter (Hemanta/Shishira)Abhyanga (Daily)Use warm, unctuous oils (Sesame oil) with light Swedana.Include nourishing foods: ghee, milk, nuts, soups, meat soup (Mamsa Rasa), and freshly cooked grains.Prevents dryness, nourishes tissues, and protects against Vata aggravation.

J Ayu Int Med Sci 2024;9(12)119
Inchara P et al. Perimenopause: A Gentle Transition through Ayurveda


Time/SeasonPracticeDetailsDietBenefits
Spring (Vasant)Abhyanga (Occasional)Use lighter oils to avoid Kapha aggravation.light foods like: barley, honey, lentil soups, and green vegetables. Avoid heavy or oily foods.Reduces Kapha accumulation, supports detoxification, and prevents sluggishness.
Summer (Greeshma)Abhyanga (Mild)Use cooling oils like Chandanadi Taila. Avoid hot oil massages.Include cooling and hydrating foods: coconut water, sweet fruits (watermelon, pomegranate), milk, and rice preparations.Prevents excessive heat, cools the body, and pacifies Pitta.
Monsoon (Varsha)Abhyanga (Regular)Use warm Mahanarayana Taila. Avoid exposure to cold and dampness.Consume warm, Vata-pacifying foods: soups, ghee, rice, moong dal, and fresh ginger-infused meals. Avoid raw and cold foods.Balances aggravated Vata, prevents stiffness, and improves digestion.
Autumn (Sharad)Abhyanga (Soothing)Use cooling oils like Chandanadi Taila to pacify Pitta.Include cooling foods: rice, milk, ghee, Amalaki and seasonal sweet fruits. Spicy and sour foods to be avoidedReduces Pitta-related symptoms like irritability, hot flashes, and excess heat.

CategoryPracticesBenefits
YogasanaTadasana (Mountain Pose)Improves posture, strengthens bones, and reduces fatigue.
Vrikshasana (Tree Pose)Enhances balance, stability, and focus.
Baddha Konasana (Butterfly Pose)Improves flexibility in the pelvic region and supports reproductive health.
Bhujangasana (Cobra Pose)Strengthens the spine, reduces back pain, and relieves fatigue.
Setu Bandhasana (Bridge Pose)Balances hormones, strengthens back, and calms the mind.
Shavasana (Corpse Pose)Relieves stress, promotes deep relaxation, and calms the nervous system.
PranayamaAnulom Vilom (Alternate Nostril Breathing)Balances Vata Dosha, reduces anxiety, and enhances mental clarity.
Bhramari Pranayama (Bee Breathing)Calms the nervous system, reduces irritability, and promotes sound sleep.
Ujjayi Pranayama (Victorious Breath)Improves energy, relieves hot flashes, and stabilizes emotions.
Nadi Shodhana (Channel Purification)Cleanses energy channels, balances Doshas, and enhances focus.

Conclusion

The treatment in Ayurveda comes in correction of the three Doshas. Balancing the three Doshas is key to ensuring the avoidance of excesses which can result in unbalanced mental and physical constituents. However, balancing the Vata Dosha becomes prime importance, whether through diet, forms of physical exercise, meditation or lifestyle factors.

The Dosha play an important role to maintain health and treatment of disease. Vata dosa can be balanced by adopting Dinacharya, Ritucharya, Vatashamana, Rasayana, Vaysthapana, Panchkarama, Sthanik Chikitsa. By adopting these perimenopause and the menopause symptoms can be treated effectively without any or nil side effects and it brings harmony to the body.

References

1. Konar H. D C Dutta's textbook of gynecology. 6th ed. New Delhi: Jaypee Brothers Medical Publishers; 2013. p. 57.

2. Hoyt LT, Falconi AM. Puberty and perimenopause: reproductive transitions and their implications for women's health. Social Science & Medicine. 2015 May 1;132:103-12.

3. Santoro N, Epperson CN, Mathews SB. Menopausal symptoms and their management. Endocrinology and Metabolism Clinics. 2015 Sep 1;44(3):497-515.

4. Patil SM, Patil VA. A review of management of menopausal syndrome through Ayurveda.

5. Ramugade DD, Shitre AA. National Journal of Research in Ayurved Science.

6. Tare PD. A Comparative Study to Evaluate the Kaalaja and Akaalaja Rajonivrutti WSR to Natural and Surgical Menopause on Stree Swasthya [Doctoral dissertation]. Rajiv Gandhi University of Health Sciences; India.


J Ayu Int Med Sci 2024;9(12)120
Inchara P et al. Perimenopause: A Gentle Transition through Ayurveda

7. Sharma RK, Dash B, editors. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office; 2004. Sutrasthan, Chapter 12, Verse no. 8. p. 237.

8. Shastri A, editor. Sushrut Samhita of Maharshi Sushrut. Reprint ed. Vol. 1. Nidansthan, Chapter 1, Verse no. 10. Varanasi: Chaowkhamba Sanskrit Sansthan; 2012. p. 297.

9. Murthy SKR, editor. Vagbhata’s Astanga Hridayam (Text, English translation, Notes etc.). Reprint ed. Vol. 1. Varanasi: Chaukhamba Orientalia; 2018. Sutrasthana, Chapter 11, Verse no. 1. p. 155.

Disclaimer / Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of Journals and/or the editor(s). Journals and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.


J Ayu Int Med Sci 2024;9(12)121